By Karen Gallagher Grant, RHIA,CHP, COO
Planning for an electronic health record (EHR) or technology conversion is slightly different for every hospital or health system, but some clear commonalities must be taken into account. During my career, I have seen some really great models, but also some bad and even ugly approaches. What follows are some of the not so pretty approaches and my advice for avoiding them.
Using the shelf
Unfortunately, there are many cases where the planning and execution of the conversion to electronic health technology somewhat lack in the passion for execution. Why? There are several reasons organizations fall from the cliff unprepared, but most, if not all, of those reasons, are avoidable. For example, one of the most specific examples of poorly planned conversion model is the lack of moving forward with a full conversion to the electronic solution. Instead, organizations implement the technology, but also make use of the “shelf.”
In this model, physicians and care staff continue to use paper records and place them on the record shelf when done making edits or changes. Intermittently they check into the electronic health record, but usually only when it’s convenient for them. The “shelf” approach is meant to be a safety net of sorts so that those who are to interact with the technology can do so on their own terms; like dipping a toe in the water when contemplating swimming – is it too cold or is it just right. In the case of the EHR, is it convenient to use right now or should I grab the paper record, notch some marks with the pen and toss it back onto the shelf, the average person thinks?
Ultimately, the thinking by administrators is that as the caregivers become more familiar with the technology, they’ll use it more and more. However, if the shelf is always there – with a paper record sitting on top – what is the incentive for the physician to log onto the electronic record and add the appropriate notes? The takeaway, from my perspective, is that such conversion attempts often lead to more stress for everyone and longer uptake times.
Another model is the partial conversion. As the name suggests, healthcare organizations only convert some departments or processes to the electronic record while others processes or departments (like coding) remain on legacy systems or (gasp) on paper. While such an approach might seem to make sense from a continuity and productivity perspective, this model leads to disparity, confusion across the organization and between departments; the creation of different “languages”; and to one of the most famous Bible stories known colloquially as the “Tower of Babel effect.”
Making matters even more complicated is when health systems don’t completely move away from non-supported legacy products when they add a new solution. Alternatively, alternatively, some organizations simply don’t want to move away from legacy (read: old) technology solutions. In cases such as this, the vendor of the legacy system may want the hospital to move or upgrade to a new solution that is supported. If the health system doesn’t move, some vendors will require payments for the use of the legacy system.
This clearly leads to the creation of chaos within the health system for all parties that are required to navigate the lack of change or the partial system conversion.
Not all the right players at the table
Finally, some administrators do not think about the conversion beyond implementation, or they don’t think about all the moving parts that must be addressed. For example, they believe that the IT team has control of all aspects of the move, but they fail to bring in the appropriate health information management (HIM) professional to go through record retention, a continuum of care, coding requirements, etc.
Bringing all the right people to the table is important for several reasons, but one of the most overlooked positions not sitting with their colleagues is probably a physician representative. Physicians need to see the complete and previous record not just pieces or what’s easily transferable through technology. This is why having all the appropriate players need to be at the table is essential. You must understand what each needs to do their job. IT, HIM, legal, finance, data retention, coding, and clinical folks must share the table during the implementation. This is even more important for those health systems that cross over regions and locales. If a health system operates in multiple states, leadership must make conversation accommodations for every region, as required or as appropriate. Managing this process requires more than the CIO and the IT department.
When all of these points are addressed, and things are in full motion, other aspects of the conversion need to be addressed, which might be best for another post entirely; however, training on the use of the technology and how processes will integrate and interact with it is very important. This should not be overlooked. There are very real impacts that can affect more than the point of care, but the revenue cycle, too.
During the conversion of electronic health technology, there are several major considerations to take into account, as we’ve covered above. Many organizations determine they need additional support and MRA can help.